| NPI | 1477855328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M STASEK Clinical Psychologist 815-388-9071 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071005965) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2010-11-29 |